富血小板凝胶联合噻吗洛尔局部外用治疗糖尿病足溃疡的研究

Study of platelet-rich gel combined with timolol for topical treatment of diabetic foot ulcers

目的探讨自体富血小板凝胶(APG)联合噻吗洛尔局部外用治疗糖尿病足(DF)溃疡的疗效及安全性。方法选取DF患者120例,随机分为单药组和联合用药组,每组60例。所有患者均给予控制血糖、常规换药、抗感染等治疗,单药组在溃疡处外用APG治疗,联合用药组再加用0.5%噻吗洛尔滴眼液。治疗4周后,比较2组溃疡面积、溃疡面缩小速率、临床疗效和不良反应。并采用酶联免疫吸附法检测2组患者血浆网膜素1及血管内皮生长因子(VEGF)水平。结果2组治疗前DF溃疡面积、血浆网膜素1和VEGF水平比较无显著差异(均P>0.05)。治疗后,联合用药组溃疡面积小于单药组[(2.78±0.65)cm^(2) vs.(3.36±0.91)cm^(2)],溃疡面缩小速率[(0.18±0.06)cm^(2)·d^(-1) vs.(0.16±0.04)cm^(2)·d^(-1)]、临床总有效率(97%vs.85%)、网膜素1[(886.43±90.24)ng·L^(-1) vs.(847.28±87.67)ng·L^(-1)]和VEGF[(79.26±15.14)ng·L^(-1) vs.(73.58±13.27)ng·L^(-1)]水平高于单药组,差异有显著意义(均P<0.05)。2组治疗过程中无严重不良反应发生。结论APG联合噻吗洛尔局部外用治疗DF溃疡具有较好的临床疗效和安全性,可能与网膜素1、VEGF升高有关。

AIM To investigate the efficacy and safety of autologous platelet-rich gel(APG)combined with timolol for topical treatment of diabetic foot(DF)ulcers.METHODS A total of 120 patients with DF were randomly divided into monotherapy group and combination group,with 60 cases in each group.All patients were treated with blood glucose control,routine dressing change,anti-infection and so on.The patients in the monotherapy group were treated with APG at the ulcers,and those in the combination group were treated with APG and 0.5%timolol eye drops.After 4 weeks of treatment,ulcer area,ulcer surface reduction rate,clinical efficacy and adverse reactions were compared between the two groups.The plasma levels of omentin-1 and vascular endothelial growth factor(VEGF)were determined by enzyme-linked immunosorbent assay.RESULTS There were no significant differences in DF ulcer area,plasma omentin-1 and VEGF levels between 2 groups before treatment(all P>0.05).After treatment,ulcer area in the combination group was smaller than that in the monotherapy group((2.78±0.65)cm^(2) vs.(3.36±0.91)cm^(2)),while ulcer surface reduction rate((0.18±0.06)cm^(2)·d^(-1) vs.(0.16±0.04)cm^(2)·d^(-1)),total clinical response rate(97%vs.85%),omentin-1((886.43±90.24)ng·L^(-1) vs.(847.28±87.67)ng·L^(-1))and VEGF((79.26±15.14)ng·L^(-1) vs.(73.58±13.27)ng·L^(-1))were significantly higher than those in the monotherapy group(all P<0.05).No serious adverse reactions occurred in both groups.CONCLUSION APG combined with timolol for topical treatment of diabetic foot ulcers has good clinical efficacy and safety,which may be related to the increase of omentin-1 and VEGF.